Costs and predictors of 30-day readmissions after craniotomy for traumatic brain injury: a nationwide analysis

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OBJECTIVE

There is increasing interest in the use of 30-day readmission (30dRA) as a quality metric to represent hospital and provider performance. Data regarding the incidence and risk factors for 30dRA after traumatic brain injury (TBI) are sparse. The authors sought to characterize these variables using a national database.

METHODS

The Nationwide Readmissions Database was used to identify patients with a primary diagnosis of TBI who underwent craniotomy or craniectomy between 2010 and 2014. Our primary outcome of interest was 30dRA. Binary logistic regression was used to identify variables related to patient demographics, comorbidities, and index hospital admission that were associated with 30dRA.

RESULTS

A total of 25,354 patients met the inclusion criteria. The 30dRA rate during the entire study period was 15.5%. In 2010 the 30dRA rate was 16.8% and in 2014 it decreased to 15.1% (pooled OR 0.90, 95% CI 0.87–0.94). The mean cost associated with a 30dRA increased slightly but significantly, from $9999 in 2010 to $10,114 in 2014 (p = 0.021). Factors associated with increased odds of 30dRA in the binary logistic regression included increased age, greater comorbidity burden, more severe injury, tracheostomy, gastrostomy, sodium abnormality, and venous thromboembolism. In order of decreasing frequency, the most common causes for 30dRA were neurological, injury/iatrogenic, cardiovascular/cerebrovascular, infectious, and respiratory.

CONCLUSIONS

The incidence of 30dRA after craniotomy for TBI decreased slightly from 2010 to 2014. This study identified several variables associated with 30dRA that require confirmation in a prospective study, which could direct attempts to prevent readmissions.

ABBREVIATIONS 30dRA = 30-day readmission; CCI = Charlson Comorbidity Index; CCS = Clinical Classifications Software; GCS = Glasgow Coma Scale; HCUP = Healthcare Cost and Utilization Project; ICISS = ICD-9 Injury Severity Score; ICP = intracranial pressure; IQR = interquartile range; LOC = loss of consciousness; LOS = length of stay; NRD = Nationwide Readmissions Database; TBI = traumatic brain injury; VTE = venous thromboembolism.

Downloadable materials

  • Supplementary Tables 1 and 2 (PDF 453 KB)

Article Information

Correspondence Haydn Hoffman: State University of New York Upstate Medical University, Syracuse, NY. hoffmanh@upstate.edu.

INCLUDE WHEN CITING Published online August 9, 2019; DOI: 10.3171/2019.5.JNS19459.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Development of the patient cohort.

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    Thirty-day readmission rates each year between 2010 and 2014 for the entire cohort. The pooled OR for readmission within 30 days after 2010 was 0.90 (95% CI 0.87–0.94). Error bars indicate standard error of the mean.

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    Median times, IQRs, and 95% CIs for time to readmission categorized by the CCS system of primary readmission diagnosis. GI = gastrointestinal; GU = genitourinary; MSK = musculoskeletal. Figure is available in color online only.

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    Annual total costs of 30dRAs (left) and mean costs of individual readmissions (right) according to year. Costs are inflation-adjusted to January 2019 US dollars. The Kruskal-Wallis H-test with post hoc analysis was used to determine differences in mean costs between years. Error bars indicate standard error of the mean. NS = not significant. * p < 0.05. Figure is available in color online only.

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